The Using Virtual Computer-Assisted Planning in Orthognathic Surgery: A Systematic Review and Meta-Analysis

Jamali, Samira; Pourarz, Sobhan; Nasrabadi, Navid; Ahmadizadeh, Hashem; Khorram, Mohammad; Darvish, Maryam

doi:10.1590/pboci.2020.064

Samira Jamali Author to whom correspondence should be addressed: Samira Jamali, Department of Endodontics, Stomatological Hospital, College of Stomatology, Xi'an Jiaotong University, Shaanxi 710004, PR China. Phone: +86 2982655450. E-mail: samira.jamali90@yahoo.com.

Department of Endodontics, Stomatological Hospital, College of Stomatology, Xi'an Jiaotong University, Shaanxi, PR China.

http://orcid.org/0000-0003-3803-1235

Sobhan Pourarz

Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.

http://orcid.org/0000-0002-7900-3671

Navid Nasrabadi

Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

http://orcid.org/0000-0002-6365-6619

Hashem Ahmadizadeh

School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.

http://orcid.org/0000-0001-7845-2638

Mohammad Khorram

Golpayegan Health Center, Isfahan University of Medical Sciences, Isfahan, Iran.

http://orcid.org/0000-0001-8254-3129

Maryam Darvish

Department of Endodontics, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran.

http://orcid.org/0000-0002-0622-4895

Author to whom correspondence should be addressed: Samira Jamali, Department of Endodontics, Stomatological Hospital, College of Stomatology, Xi'an Jiaotong University, Shaanxi 710004, PR China. Phone: +86 2982655450. E-mail: samira.jamali90@yahoo.com.

Academic Editors: Alessandro Leite Cavalcanti and Wilton Wilney Nascimento Padilha

Authors’ Contributions

SJ Conceptualization, Methodology, Investigation, Formal Analysis, Writing - Original Draft Preparation and Writing - Review and Editing.

SP Writing - Review and Editing.

NN Writing - Original Draft Preparation and Writing - Review and Editing.

HA Writing - Review and Editing.

MK Writing - Review and Editing.

MD Formal Analysis and Writing - Original Draft Preparation.

All authors declare that they contributed to critical review of intellectual content and approval of the final version to be published.

Conflict of Interest

The authors declare no conflicts of interest.

Author	Number of Patients	Imaging Method	Imaging of Dental Arches	Software Used for Virtual Planning	Surgical Splint	Planning Time	Conclusions
Centenero et al. [⁷[7] Aboul-Hosn Centenero S, Hernández-Alfaro F. 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results -our experience in 16 cases. J Craniomaxillofac Surg 2012; 40(2):162-8. https://doi.org/10.1016/j.jcms.2011.03.014 https://doi.org/10.1016/j.jcms.2011.03.0... ]	16	CT, CBCT	A scan of the plaster model	SimPlant Pro OMS 10.1 (Materialise Dental, Leuven, Belgium)	Occlusal Splint	NA	The Software program used in the study is reliable for 3D planning and for the manufacture of surgical splints using CAD/CAM technology.
Luebbers et al. [⁸[8] Sun Y, Luebbers HT, Agbaje JO, Schepers S, Vrielinck L, Lambrichts I, et al. Accuracy of upper jaw positioning with intermediate splint fabrication after virtual planning in bimaxillary orthognathic surgery. J Craniofac Surg 2013; 24(6):1871-6. https://doi.org/10.1097/SCS.0b013e31829a80d9 https://doi.org/10.1097/SCS.0b013e31829a... ]	15	CBCT	A Scan of bite registration with reference points for image fusion with CT	Amira (Visage Imaging GmbH, Germany)	Occlusal Splint	255 min	The accuracy of the designed intermediate splint met the requirements for bimaxillary surgery under clinical circumstances.
Li et al. [⁹[9] Li B, Zhang L, Sun H, Yuan J, Shen SGF, Wang X. A novel method of computer-aided orthognathic surgery using individual CAD/CAM templates: a combination of the osteotomy and repositioning guides. Br J Oral Maxillofac Surg 2013; 51(8):e239-e44. https://doi.org/10.1016/j.bjoms.2013.03.007 https://doi.org/10.1016/j.bjoms.2013.03.... ]	6	CT	CT with bite registration	SurgiCase CMF 5.0 (Materialise, Leuven, Belgium) Unigraphics NX 7.5 (Siemens PLM Software, TX, USA)	Occlusal Splint Bone Splint (Maxilla)	145 min	CAD/CAM templates provide a reliable method for transfer of maxillary surgical planning, which may be a useful alternative to the intermediate splint technique.
Zinser et al. [¹⁰[10] Zinser MJ, Sailer HF, Ritter L, Braumann B, Maegele M, Zöller JE. A paradigm shift in orthognathic surgery? A comparison of navigation, computer-aided designed/computer-aided manufactured splints, and "classic" intermaxillary splints to surgical transfer of virtual orthognathic planning. J Oral Maxillofac Surg 2013; 71(12):2151.e1-21. https://doi.org/10.1016/j.joms.2013.07.007 https://doi.org/10.1016/j.joms.2013.07.0... ]	28	CT, CBCT	A scan of plaster model	SimPlant Pro OMS 10.1 (Materialise Dental, Belgium)	Occlusal Splint Bone Splint	NA	CAD/CAM splints and surgical navigation provide a reliable, innovative, and precise approach for the transfer of virtual orthognathic planning.
Shaheen et al. [¹¹[11] Shaheen E, Coopman R, Jacobs R, Politis C. Optimized 3D virtually planned intermediate splints for bimaxillary orthognathic surgery: a clinical validation study in 20 patients. J Craniomaxillofac Surg 2018; 46(9):1441-7. https://doi.org/10.1016/j.jcms.2018.05.050 https://doi.org/10.1016/j.jcms.2018.05.0... ]	20	CT, CBCT	Virtual 3D planning-printing	The software to design the intermediate and final splints (Proplan software - Materialise, Leuven, Belgium). The designed splints were printed in biocompatible material using Objet Connex 350 (Stratasys, Eden Prairie, Minnesota, USA) with slice thickness of 0.03 mm.	Occlusal Splint	NA	19 out of the 20 intermediate digitally 3D printed splints were clinically accepted

Study	Postoperative Period	General Mean (SD)	Maxilla Mean (SD)	Mandible Mean (SD)	Chin Mean (SD)	Mandibular Condyle Mean (SD)
Centenero et al. [7]	3 Months	Soft tissue 0.7240.310 (0.053-0.970) ICCa Angles: 0.8670.164 (0.624-0.970) ICCa Lines: 0.6080.368 (0.053- 0.947) ICCa Bone tissue 0.7220.246 (0.350-0.964) ICCa Angles: 0.6550.249 (0.350-0.910) ICCa Lines: 0.9220.059 (0.880- 0.964)	OcPl: 0.375 (0.178 to 0.739) ICCa (FHP)	MdPl: 0.608 (0.162 to 0.849) ICCa (FHP)	MdPl: 0.608 (0.162 to 0.849) ICCa (FHP)	NA
Luebbers et al. [8]	6 Weeks	NA	Sagittal: 0.50.22 mm (0 to 0.9) Vertical: 0.570.35 mm (0.2 to 1.4) Transversal: 0.380.35 mm (0 to 1.3)	NA	NA	NA
Li et al. [9]	3 Days	<1mm (0.03-1.7)	<1mm (0.03-1.7)	NA	NA	NA
Zinser et al. [10]	6 Months	NA	Sagittal: <0.14 mm (VS) Sagittal: <0.61 mm (CS) Vertical: <0.23 mm (VS) Vertical: <1.3 mm (CS) Transversal: <0.04 mm (VS) Transversal: <0.43 mm (CS) MxPl: 0.358 (FHP)-0.038 (MFP) (VS) MxPl: 0.638 (FHP) 0.468 (MFP)(CS) OcPl: 0.028 (FHP) 0.038 (MFP) (VS) OcPl: 0.958 (FHP)-0.368 (MFP) (CS) Soft Tissue Sagittal: <1.39 mm (VS) Sagittal: <2.1 mm (CS) Vertical: <2.52 mm (VS) Vertical: <4.3 mm (CS) Transversal: <1.2 mm (VS) Transversal: <2.5 mm (CS)	Sagittal: <0.17 mm (VS) Sagittal: <0.94 mm (CS) Vertical: <0.33 mm (VS) Vertical: <1.8 mm (CS) Transversal: <0.17 mm (VS) Transversal: <0.58 mm (CS) MdPl: 0.588 (FHP) - 0.618 (MFP) (VS) MdPl: 10.258 (FHP) - 1.18 (MFP) (CS) Soft Tissue Sagittal: 0.09 mm (VS) Sagittal: 0.74 mm (CS) Vertical: <0.48 mm (VS) Vertical: 1.5 mm (CS) Transversal: 1.1 mm (VS) Transversal: 1.3 mm (CS)	NA	Sagittal: 0.18 mm (VS) Sagittal: 0.61 mm (CS) Vertical: 0.13 mm (VS) Vertical: 0.5 mm (CS) Transversal: 0.07 mm (VS) Transversal: 0.5 mm (CS) CoL-ZFS: 0.058 (VS) CoL-ZFS: 0.518 (CS)
Shaheen et al. [11]	3 Months	NA	OcPl: 0.275 (0.178 to 0.739) ICCa	NA	NA	NA

Quality Criteria for Studies	Study
	[⁷[7] Aboul-Hosn Centenero S, Hernández-Alfaro F. 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results -our experience in 16 cases. J Craniomaxillofac Surg 2012; 40(2):162-8. https://doi.org/10.1016/j.jcms.2011.03.014 https://doi.org/10.1016/j.jcms.2011.03.0... ]	[⁸[8] Sun Y, Luebbers HT, Agbaje JO, Schepers S, Vrielinck L, Lambrichts I, et al. Accuracy of upper jaw positioning with intermediate splint fabrication after virtual planning in bimaxillary orthognathic surgery. J Craniofac Surg 2013; 24(6):1871-6. https://doi.org/10.1097/SCS.0b013e31829a80d9 https://doi.org/10.1097/SCS.0b013e31829a... ]	[⁹[9] Li B, Zhang L, Sun H, Yuan J, Shen SGF, Wang X. A novel method of computer-aided orthognathic surgery using individual CAD/CAM templates: a combination of the osteotomy and repositioning guides. Br J Oral Maxillofac Surg 2013; 51(8):e239-e44. https://doi.org/10.1016/j.bjoms.2013.03.007 https://doi.org/10.1016/j.bjoms.2013.03.... ]	[¹⁰[10] Zinser MJ, Sailer HF, Ritter L, Braumann B, Maegele M, Zöller JE. A paradigm shift in orthognathic surgery? A comparison of navigation, computer-aided designed/computer-aided manufactured splints, and "classic" intermaxillary splints to surgical transfer of virtual orthognathic planning. J Oral Maxillofac Surg 2013; 71(12):2151.e1-21. https://doi.org/10.1016/j.joms.2013.07.007 https://doi.org/10.1016/j.joms.2013.07.0... ]	[¹¹[11] Shaheen E, Coopman R, Jacobs R, Politis C. Optimized 3D virtually planned intermediate splints for bimaxillary orthognathic surgery: a clinical validation study in 20 patients. J Craniomaxillofac Surg 2018; 46(9):1441-7. https://doi.org/10.1016/j.jcms.2018.05.050 https://doi.org/10.1016/j.jcms.2018.05.0... ]
Sample Randomization	No	No	No	No	No
Comparison Between Treatments	No	No	No	Yes	No
Blind Assessment	Yes	Yes	No	No	No
Validation of Measurements	No	Yes	Yes	Yes	No
Statistical Analysis	No	Yes	Yes	Yes	Yes
Defined Inclusion and Exclusion Criteria	Yes	Yes	Yes	Yes	Yes
Report on Follow-Up	Yes	Yes	Yes	Yes	Yes
Risk of Bias Assessment	High	High	High	Medium	High

Study	95% Confidence Interval		% Weight
Study	Upper	Lower	% Weight
Centenero et al. [⁷[7] Aboul-Hosn Centenero S, Hernández-Alfaro F. 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results -our experience in 16 cases. J Craniomaxillofac Surg 2012; 40(2):162-8. https://doi.org/10.1016/j.jcms.2011.03.014 https://doi.org/10.1016/j.jcms.2011.03.0... ]	10.800	-8.800	22.78
Luebbers et al. [⁸[8] Sun Y, Luebbers HT, Agbaje JO, Schepers S, Vrielinck L, Lambrichts I, et al. Accuracy of upper jaw positioning with intermediate splint fabrication after virtual planning in bimaxillary orthognathic surgery. J Craniofac Surg 2013; 24(6):1871-6. https://doi.org/10.1097/SCS.0b013e31829a80d9 https://doi.org/10.1097/SCS.0b013e31829a... ]	11.800	-7.800	22.78
Li et al. [⁹[9] Li B, Zhang L, Sun H, Yuan J, Shen SGF, Wang X. A novel method of computer-aided orthognathic surgery using individual CAD/CAM templates: a combination of the osteotomy and repositioning guides. Br J Oral Maxillofac Surg 2013; 51(8):e239-e44. https://doi.org/10.1016/j.bjoms.2013.03.007 https://doi.org/10.1016/j.bjoms.2013.03.... ]	12.800	-6.800	22.78
Zinser et al. [¹⁰[10] Zinser MJ, Sailer HF, Ritter L, Braumann B, Maegele M, Zöller JE. A paradigm shift in orthognathic surgery? A comparison of navigation, computer-aided designed/computer-aided manufactured splints, and "classic" intermaxillary splints to surgical transfer of virtual orthognathic planning. J Oral Maxillofac Surg 2013; 71(12):2151.e1-21. https://doi.org/10.1016/j.joms.2013.07.007 https://doi.org/10.1016/j.joms.2013.07.0... ]	15.760	-7.760	15.82
Shaheen et al. [¹¹[11] Shaheen E, Coopman R, Jacobs R, Politis C. Optimized 3D virtually planned intermediate splints for bimaxillary orthognathic surgery: a clinical validation study in 20 patients. J Craniomaxillofac Surg 2018; 46(9):1441-7. https://doi.org/10.1016/j.jcms.2018.05.050 https://doi.org/10.1016/j.jcms.2018.05.0... ]	16.760	-6.760	15.82

[1] Author to whom correspondence should be addressed: Samira Jamali, Department of Endodontics, Stomatological Hospital, College of Stomatology, Xi'an Jiaotong University, Shaanxi 710004, PR China. Phone: +86 2982655450. E-mail: samira.jamali90@yahoo.com.

Brasil

Brasil

The Using Virtual Computer-Assisted Planning in Orthognathic Surgery: A Systematic Review and Meta-Analysis

Abstract

Objective:

Material and Methods:

Results:

Conclusion: